Synopsis

While the threat of tuberculosis (TB) is recognised globally, the prevalence of the disease is often under-appreciated, according to the EDD2017 discussion panel. With 10.4 million new cases worldwide in 2015 and a death toll of 1.4 million, TB very much remains a significant global public health concern.

The UN’s Sustainable Development Goals target the end of the global TB epidemic by 2030. Similarly, the World Health Organization’s End TB Strategy is aimed at a

95 % reduction, by 2035, in the number of TB deaths compared with 2015, alongside a 90 % reduction in the TB incidence rate.

Achieving these ambitious targets will require significant effort and cooperation. The panel noted that the global response to the TB epidemic has been comparatively slow and too heavily slanted towards a biomedical approach.

While free treatment is essential, it is not enough as accessing local clinics is not cost-free for people and local healthcare provision can be inadequate and compromise the quality of care. Civil society actors are bridging this gap by stepping in to combat the spread of TB and organising follow-up visits to ensure better treatment outcomes.

Â rise in drug resistance is one of the challenges in the treatment of TB. Although prevention is possible via vaccination, it only works for certain strains of the disease. If the patient is not drug-resistant, a six-month treatment will cure TB. Where there is drug resistance, the treatment is much harder on the patient. Therefore, patient-level support to improve completion of treatment is vitally important.

An effective pathway to combating TB is to target at-risk groups with a proactive approach. Rather than wait for the patient to present with debilitating symptoms, the objective is early diagnosis and the prompt initiation of treatment. Such intervention makes sense in certain settings; for example, for miners in South Africa who have the highest rates of TB in the world due to occupational risk factors, mobility levels and discontinuity of care. A Global Fund TB in the mining sector programme in the Southern African Development Community SADC region is delivering good results. This civil society approach involves three steps:

Social mobilisation – led by trained field staff and community volunteers – to raise awareness and create demand

Patient-based support, including counselling and preventive treatment for family members

A number of key learnings have emerged. Targeted screening requires careful planning with all stakeholders. Workplace activity should be combined with household visits. A grassroots approach helps to ensure acceptability of screening and testing, thus overcoming fear of social stigma that can prevent some from seeking treatment. TB diagnosis requires substantial follow-up and patient-level support is key to treatment completion, particularly when it is combined with vulnerable and food-insecure settings.

The mining sector example above is illustrative of how the most effective way to tackle the challenge of TB is to use a multistakeholder approach. Local NGOs, mine-workers’ unions, mining companies large and small, government agencies and health clinics need to work together to tackle this societal problem.

Insight

Dealing with illnesses such as TB or HIV requires the trust of workers, communities and mining companies – and establishing this trust takes time. Yet treatment programmes typically don’t fund the pre-launch cooperation activity that would allow the programme to hit the ground running.